Why do medical doctors put patients in an induced coma? And what medication is used?
We should make distinctions here:Many patients require sedation in the ICU because it helps make treatment with some kinds of ICU treatment more tolerable, such as those patients who require mechanical ventilation and at times it can be used to control agitation. Such patients however are not in a coma and are sedated as lightly as possible.There are other patients who require very deep sedation even to the extent they are essentially unarousable/comatose, This can occur in the following settings:Where the patient is being given mechanical ventilation using a set up which requires the patients respiratory efforts need to be suppressed so as to avoid fighting or working against the ventilator, often this is combined with giving an agent to temporarily paralyze the patient as well.In situations in which deep sedation is being used to protect the brain, this may occur when the brain is very swollen and the pressure in side the skull ( called the intracranial pressure) is very high. In such cases deep sedation can lower the brains metabolic demands and blood flow requirements and indirectly lower the pressure in the skull. It can also be a technique to control very severe epileptic seizures which are occurring one rate after the other non stop ( status epilepticus)The agents used can vary and are complicated by the fact that many of them used in very high doses required to deeply sedate can have adverse effects on blood pressure and be difficult to reverse, so drugs may be used in combination but in generalShort acting benzodiazipines ( drugs like valium, a common one being Midazolam)A general anesthetic like drug called “propofol”Older approaches which may be used from time to time included the short acting barbiturate “pentobarbital”
What are the reasons doctors put patients in medically-induced comas?
In her case, she suffered a cardiac arrest. One of the things we've learned over the last 20 years about resuscitation is that one of the most dangerous parts is AFTER the resuscitation. The brain is particularly susceptible to damage after a cardiac arrest. The surprising thing we've found is that much of the damage occurs when the blood flow is suddenly restored to the brain. Those cells have been in an hypoxic, acidic environment for the duration of the resuscitation attempt. When good circulation is suddenly restored, those cells can die very quickly. This is called reperfusion injury and it is a significant cause of post-resuscitation mortality. The fix is to lower the metabolic demands of the brain. The brain uses a lot of oxygen and a lot of sugar when it's active. If you can lower the demand the brain has for oxygen, then you can limit the damage from reperfusion injury. We do this by two methods: either induced hypothermia or a medically induced coma. In a medically induced coma, we give a barbiturate that slows brain activity. We monitor the EEG continuously to keep the drug at the lowest levels necessary to minimize brain activity. When the brain is quiet, it uses much less oxygen. By inducing a coma, we can restore perfusion, let the body recover a bit, then reduce the barbiturate level to bring the brain activity back up to normal. This seems to do a good job of preventing reperfusion injury and anoxic brain damage. In Joan Rivers' case, she stopped breathing during a bronchoscopy and suffered a cardiac arrest. I suspect she was not at a facility that had the capability of starting a hypothermia protocol and so they elected to induce a coma. It's going to take a few days before they'll start to bring her out and see if there was any brain damage that resulted from the arrest. . .
Why do some doctors treat a patient with a medically-induced coma? Are there cases where the patient cannot be awakened from the coma?
The term medically-induced coma is wrong; what you mean is heavy sedation. Sedation can be just enough so you’re not anxious to the point of not reacting even to pain (the absence of reaction to pain is the definition of coma, and that’s where the term was born).Some clinical conditions (imagine being in a car crash and having 10 broken ribs on your right side, 8 on the left, a couple more broken bones and multiple contusions. Contusions are like bruises that you get in the brain, heart, liver, lungs, etc. You will be in a world of pain and every breath will be like being stabbed multiple times, so you won’t breath like your body needs. In that case you will need ventilation support and sedation (and analgesia) so you don’t fight against the ventilator - which is basically a machine blowing air into your lungs (instead of what naturally occurs in your inspiration where air is pulled into the lungs. It’s not pleasant, the presence of the tube just by itself is uncomfortable or even painful. Either you are sedated until you are better or you will fight against the ventilator, work against each other and you will decompensate your breathing even further (and that will lead to a world of problems like changes in your blood pH (the blood acidity).Some people don’t wake up from sedation because they have problems that don’t allow them to. Getting back to the car crash, during the crash your brain is shaken inside your skull and that shake can be as severe as to cause a condition called Diffuse Axonal Injury, wich may not present any symptoms in the first days after the crash (there’s the typical description of the patient that is neurologically fine after the crash and suddenly on the fifth day after the crash goes into a sudden coma (here the term coma is appropriate) and may never wake up, or wake up with severe limitations.Another instance is the case where patients suffer a stroke while under sedation, and when the sedatives are stopped they won’t wake up or will wake up with neurological impairments.
Can a doctor put you in a medicaly induced coma? and how much would it cost.?
Im wondering if its legal for you to ask a doctor to put you in a medicaly induced coma, and how much it alone would cost. Im wondering cause it seems intresting cause you go to sleep one moment then wake up a month or 2 later.
If somone is put under a medical induced coma with ativan and they are not an alcoholic can it hurt them?
Ativan is a very safe drug for sedating a ventilator patient. The half-life is about 4 hours, and it results in a twilight state rather than a full coma (they use phenobarbital for medically induced coma), so she is able to hear you. The medical definition of alcoholism may be different from your definition. Stedman's Medical Dictionary defines alcoholism as follows: "alcohol abuse, dependence, or addiction; chronic heavy drinking (more than 2 drinks/day, or binge drinking) or intoxication resulting in impairment of health, dependency as a coping mechanism, and increased adaptation to the effects of alcohol requiring increasing doses to acheive and sustain a desired effect. Specific signs and symptoms are usually shown upon sudden cessation of drinking."
Why would doctors put someone in a medically induced coma for pneumonia?
Respiratory failure that requires intubation requires sedation. Propofol, fentanyl, and versed are commonly used for this type of sedation. These drugs make it easier to tolerate the tube in their throat, make it easier to cough, rest while the ventilator does most of the work of breathing and the ordeal goes quick for the patient. Occasionally patients deteriorate to a point where paralytics are used to place patients in an ‘induced coma’. Infiltrates in the lungs will settle in the most dependant portions of the lungs and ARDS can bring edema and fluids making it very difficult to exchange oxygen and CO2. If it is becoming increasingly difficult to oxygenate and repositioning isn't helping, they may have to be turned in a prone position. At this point we want all oxygen consumption to be for maintaining vital organ system needs. If it comes to this, things are definitely critical.
Why must doctors sometimes medically-induce comas?
The most frequently induced medical comas are anesthesia for an operation. But there are other cases for inducing coma, such as status epileptics, to prevent injury to the brain. What Is a Medically Induced Coma and Why Is It Used?